Personal Health Goals Research Articles

Older Veterans' perspectives on participation in a clinical exercise program: A qualitative study of the VA Gerofit exercise program.

We explored the perspectives of older veterans in Gerofit, a Department of Veteran Affairs (VA) supervised clinical exercise program, to understand the factors associated with participation and how the program supported personal health goals. Twenty semistructured interviews were conducted with active and inactive Gerofit participants. We used a hybrid inductive and deductive approach to thematic analysis of transcripts, with the latter informed by the Health Action Process Approach model of behavior change. Active and inactive participants differed in their perspectives about how Gerofit impacted their progress toward meeting personal health goals. Active participants noted program features (e.g., schedule, staffing) as facilitators and suggested greater self-efficacy about program participation compared to inactive participants. Both groups perceived the camaraderie with other veterans as a facilitator. Exercise program features, including camaraderie, are important factors that affect the ability of older veterans to participate in exercise and achieve personal health goals.

Peer-supported mobile mental health for veterans in primary care: A pilot study.

One in four veteran primary care patients suffers from a mental health condition; however, most do not receive any treatment for these problems. Mobile health (mHealth) can overcome barriers to care access, but poor patient engagement limits the effectiveness and implementation of these tools. Peers may facilitate patient engagement with mHealth. We designed a protocol for peers to support implementation of mobile mental health tools in primary care and tested the feasibility, acceptability, and clinical utility of this approach. Thirty-nine patients across two Veterans Affairs sites who screened positive for depression during a primary care visit and were not currently in mental health treatment were enrolled. Participants were scheduled for four phone sessions with a peer over 8 weeks and introduced to five mobile apps for a range of transdiagnostic mental health issues (stress, low mood, sleep problems, anger, and trauma). Pre/post phone interviews using quantitative and qualitative approaches assessed participants' self-reported app use, satisfaction with the intervention, symptom change (stress, anxiety, depression, insomnia), and progress with personal health goals. On average, patients reported using 3.04 apps (SD = 1.46). Per the Client Satisfaction Questionnaire, global satisfaction with the intervention was high (M = 25.71 out of 32, SD = 3.95). Pre to post participants reported significant improvements in their level of stress, based on a quantitative measure (p = .008), and 87% reported progress on at least one personal health goal. Findings support the feasibility, acceptability, and clinical utility of peer-supported mobile mental health for veterans in primary care. A randomized controlled trial of an adaptive version of this intervention is recommended. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived value and benefits of the Community Paramedicine at Clinic (CP@clinic) programme: a descriptive qualitative study

ObjectivesCommunity Paramedicine (CP) is increasingly being used to provide chronic disease management for vulnerable populations in the community. CP@clinic took place in social housing buildings to support cardiovascular health and...

Health goals amongst patients with Crohn's disease.

Inflammatory bowel diseases, including Crohn's disease, have a significant impact on patients' lifestyle, requiring lifelong attention to health behavior. The aim of our study was to investigate health-related goals, emotions related to health goals, the use of infocommunication tools and their associations. 79 patients with Crohn's disease (59.5% female, mean age 40.7 years, SD = 11.89) participated in the study. They answered demographic and health behaviour questions and completed the Personal Health Plans Questionnaire, which assessed their personal health goals, positive and negative emotions about health goal(s), support for personal health goals from their physician, negative and positive effects (barriers/support) of achieving health goals, and digital technology and internet use. 70% of patients had at least 1 health goal. The health goals were classified into four categories: physical activity (43.6%), stress management (25.4%), nutrition (18%) and smoking cessation (7%). 71% of participants experienced at least average levels of positive emotions related to the health goal, but about 50% also experienced negative emotions. 51% of those with a health goal regularly use the internet and apps on smartphones. Infocommunication device use showed a medium-strength correlation with perceived health goal-related barrier/support (ρ = 0.55, p<0.01), support from the person's doctor (ρ = 0.45, p<0.05) and physical activity (ρ = 0.40, p<0.01). More than two-thirds of patients had a health goal; most of the goals were related to health behaviours that are also relevant to Crohn's disease, but few had healthy eating and smoking cessation as health goals. Half of those with a health goal regularly use the internet and apps on smartphones. Among health behaviours, physical activity was associated with infocommunication device use. It is recommended to investigate patients' health goals and infocommunication device use in the care of patients with Crohn's disease. This would allow the development of specific interventions to improve their health behaviour, which could increase the quality of life and disease prognosis. Orv Hetil. 2023; 164(28): 1102-1110.

VHA Whole Health Services and Complementary and Integrative Health Therapies: a Gateway to Evidence-Based Mental Health Treatment.

Engagement in evidence-based psychotherapy (EBP) among veterans with behavioral health conditions is often low. The Veterans Health Administration (VHA) is implementing a "Whole Health (WH)" system of care, to identify veteran personal health goals, align care with those goals, and offer services designed to engage and empower veterans to achieve well-being. To examine the relationship between veteran WH utilization and subsequent engagement in EBP. Retrospective analysis of VHA administrative records from 18 facilities implementing WH. Veterans (n = 265,364) with a diagnosis of depression, post-traumatic stress disorder (PTSD), and/or anxiety who had a mental healthcare encounter but no EBP use in fiscal year (FY) 2018. Among this cohort, 33,146 (12.5%) began using WH in FY2019. We examined use of an EBP for depression, anxiety, and/or PTSD within 1year of the index date of WH use compared to use of an EBP anytime during FY2019 for veterans not identified as using WH. We used multiple logistic regression to examine the association between veteran WH use and EBP engagement. Approximately 3.0% (n = 7,860) of the veterans in our overall cohort engaged in an EBP in the year following their index date. Controlling for key demographic, health, and utilization variables, WH users had 2.4 (95% CI: 2.2-2.5) times higher odds of engaging in an EBP the following year than those with no WH utilization. Associations between utilization of specific WH services (vs. no utilization of that service) and engagement in an EBP in the subsequent year ranged from 1.6 (95% CI: 1.0-2.6) to 3.5 (95% CI: 3.2-3.9) across the different types of WH services used. WH use was associated with increased engagement in EBPs among veterans with depression, anxiety, and/or PTSD. Future interventions intended to promote veteran engagement in EBPs may benefit from leveraging WH services and therapies.

Using a person-centered approach in clinical care for patients with complex chronic conditions: Perspectives from healthcare professionals caring for Veterans with COPD in the U.S. Veterans Health Administration's Whole Health System of Care.

The largest nationally integrated health system in the United States, the Veterans Health Administration (VHA), has been undergoing a transformation toward a Whole Health (WH) System of Care. WH Clinical Care, a component of this system, includes holistically assessing the Veteran's life context, identifying what really matters to the Veteran, collaboratively setting and monitoring personal health and well-being goals, and equipping the Veteran with access to conventional and complementary and integrative health resources. Implementation of WH Clinical Care has been challenging. Understanding healthcare professionals' perspectives on the value of and barriers and facilitators to practicing WH Clinical Care holds relevance for not only VHA's efforts but also other health systems, in the U.S. and internationally, that are engaged in person-centered care implementation. We sought to understand perspectives of healthcare professionals at VHA on providing WH Clinical Care to Veterans with COPD, as a lens to understand the broader issue of WH Clinical Care for Veterans living with complex chronic conditions. We interviewed 25 healthcare professionals across disciplines and services at a VA Medical Center in 2020-2021, including primary care providers, pulmonologists, palliative care providers, and chaplains. Interview transcripts were analyzed using qualitative content analysis. Each element of WH Clinical Care raised complex questions and/or concerns, including: (1) the appropriate depth/breadth of inquiry in person-centered assessment; (2) the rationale for elicitation of what really matters; (3) the feasibility and appropriate division of labor in personal health goal setting and planning; and (4) challenges related to referring Veterans to a broad spectrum of supportive services. Efforts to promote person-centered care must account for healthcare professionals' existing comfort with its elements, advocate for a team-based approach, and continue to grapple with the conflicting structural conditions and organizational imperatives.

Is paid sick leave bad for business? A systematic review.

Vigorous legislative activity both for and against paid sick leave has occurred over the last decade. Although a compelling body of evidence suggests thatpaid sick leave supports personal and public health goals, a notable barrier in opposition to paid sick leave is apprehension about the potential short-term and long-term harms to business. This review critically assesses the relationship between paid sick leave and favorable or unfavorable business conditions. Utilizing thePreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically review six research databases between 2000 and November 2022. Of 2664 studies identified, 123 were considered potentially relevant and 43 were included in the review. In addition to absence from work, paid sick leave was associated with favorable business conditions such as increased job satisfaction; improved retention;andreductions in occupational injury, contagion, presenteeism, and death; as well as some measures of firm performance and labor market conditions. Overall, our review discovered more evidence supporting the relationship between paid sick leave and favorable business conditions ascompared with evidence thatsupported unfavorable business conditions. Although more research is needed, these findings can be used to inform firm-level and public policy decisions about paid sick leave.

StudyMe: a new mobile app for user-centric N-of-1 trials

N-of-1 trials are multi-crossover self-experiments that allow individuals to systematically evaluate the effect of interventions on their personal health goals. Although several tools for N-of-1 trials exist, there is a gap in supporting non-experts in conducting their own user-centric trials. In this study, we present StudyMe, an open-source mobile application that is freely available from https://play.google.com/store/apps/details?id=health.studyu.me and offers users flexibility and guidance in configuring every component of their trials. We also present research that informed the development of StudyMe, focusing on trial creation. Through an initial survey with 272 participants, we learned that individuals are interested in a variety of personal health aspects and have unique ideas on how to improve them. In an iterative, user-centered development process with intermediate user tests, we developed StudyMe that features an educational part to communicate N-of-1 trial concepts. A final empirical evaluation of StudyMe showed that all participants were able to create their own trials successfully using StudyMe and the app achieved a very good usability rating. Our findings suggest that StudyMe provides a significant step towards enabling individuals to apply a systematic science-oriented approach to personalize health-related interventions and behavior modifications in their everyday lives.

MHealth App Barriers, Usability, and Personalization: A Cross-Sectional Study from Egypt and Saudi Arabia.

Mobile health (mHealth) has emerged as a substantial segment of eHealth. Herein, we conducted a cross-sectional study to investigate mHealth app barriers, usability, and personalization in Egypt and Saudi Arabia. We used a Google survey to recruit participants from both countries between the 15th of September and the 15th of October 2022. Among 299 participants (247 from Egypt and 52 from Saudi Arabia), aged ≥ 18 years, 27.4% reported mHealth app use. In the age-, sex-, and country-adjusted regression models, age > 25 years: OR (95% CI) = 1.98 (1.11, 3.54), residing in Saudi Arabia: OR (95% CI) = 4.33 (2.22, 8.48), and physical activity: OR (95% CI) = 2.53 (1.44, 4.44) were associated with mHealth app use. The main mHealth app purposes were lifestyle promotion (35.4%), diet and nutrition (30.5%), and administrative services (13.4%). On a scale from 20 to 100, mHealth app usability scores were 46.3% (20−40), 7.3% (41−60), 31.7% (61−80), and 14.7% (81−100). According to 93.9% of users, mHealth app features were modifiable to meet personal health goals, while 37% stated that mHealth apps helped them set new personal health goals. In conclusion, age, residing in Saudi Arabia (compared to Egypt), and physical activity were positively associated with mHealth app use. mHealth app feature personalization and helping users set new personal health goals were largely reported, suggesting that mHealth has the potential to help put personalized healthcare into practice.

A social robot-based platform for health behavior change toward prevention of childhood obesity

Childhood obesity is a major public health challenge which is linked with the occurrence of diseases such as diabetes and cancer. The COVID-19 pandemic has forced changes to the lifestyle behaviors of children, thereby making the risk of developing obesity even greater. Novel preventive tools and approaches are required to fight childhood obesity. We present a social robot-based platform which utilizes an interactive motivational strategy in communication with children, collects self-reports through the touch of tangible objects, and processes behavioral data, aiming to: (a) screen and assess the behaviors of children in the dimensions of physical activity, diet, and education, and (b) recommend individualized goals for health behavior change. The platform was integrated through a microservice architecture within a multi-component system targeting childhood obesity prevention. The platform was evaluated in an experimental study with 30 children aged 9–12 years in a real-life school setting, showing children’s acceptance to use it, and an 80% success rate in achieving weekly personal health goals recommended by the social robot-based platform. The results provide preliminary evidence on the implementation feasibility and potential of the social robot-based platform toward the betterment of children’s health behaviors in the context of childhood obesity prevention. Further rigorous longer-term studies are required.

A 3‐D approach to personalised nutrition

A <scp>3‐D</scp> approach to personalised nutrition

Mobile health apps: An assessment of needs, perceptions, usability, and efficacy in changing dietary choices

ObjectiveThe aim of this study was to explore the use of mobile health applications as dietary self-monitoring tools, and their possible role in improving food choices. MethodsThis descriptive, cross-sectional study used self-administered surveys conducted among students (aged 18–25 y) and consisted of two phases. Phase 1 (N = 991; 65.9% women; mean age: 20.78 ± 1.51 y) assessed the need for and perceptions of mobile health applications to serve as dietary assessment tools. Phase 2 (N = 61; 75.4% women) comprised a 3-wk period of using MyFitnessPal; its corresponding survey assessed the application's usability and perceived efficacy in changing dietary choices. Dietary Instrument for Nutrition Education scores (part of both surveys), assessing dietary intake, were compared using a paired t test. P < 0.05 was considered statistically significant. ResultsMost participants wanted to improve their diet to be healthier (89.7%) and to improve their weight (74.2%), and actively searched for information on how to accomplish this (55.7%). MyFitnessPal was reported to be easy to use (93.4%); however, difficulties were experienced in the selection of food items (39.3%) and portion sizes (63.9%). Users reported that MyFitnessPal helped them change their dietary intake (91.8%) and advance toward their personal weight and health goals (65.6%). A significant reduction in high-sugar food intake after the use of MyFitnessPal (P = 0.03) was found. ConclusionMost participants searched for information on how to improve their diet. MyFitnessPal, a mobile health app with a diet-tracking feature, was reported to be helpful in changing dietary intake; furthermore, use of the application over a 3-wk period led to a significant reduction in sugary food intake.

Mobile Health to Support Community-Integration of Individuals With Disabilities Using iMHere 2.0: Focus Group Study.

BackgroundMobile health (mHealth) systems that support self-management can improve medical, functional, and psychosocial outcomes for individuals with disabilities and chronic conditions. The mHealth systems can potentially be expanded to support community integration.ObjectiveThe purposes of this study were to (1) partner with a community-based organization that supports community integration of individuals with disabilities; (2) identify software requirements needed to support community participation; and (3) iteratively refine an existing mHealth application to include new requirements.MethodsCommunity Living and Support Services (CLASS), a nonprofit organization that serves individuals with disabilities in Pittsburgh, Pennsylvania, was identified as the focus group for this study. Key stakeholders within the Community Partners Program at CLASS proposed design requirements for an existing mHealth application, Interactive Mobile Health and Rehabilitation (iMHere) 2.0, that has been used to support self-management.ResultsWe gathered qualitative data from a focus group composed of CLASS members to develop and iteratively revise iMHere 2.0 to include new modules and features to support community integration. A caregiver app was also developed. The new system contains features to support finance, transportation, client and caregiver communication, calendar and checklist management, upcoming medical and nonmedical appointments, social engagement, pain management, and access to a personal profile. Modifications were made to the following existing modules: education, mood, personal health record, goals, medications, and nutrition.ConclusionsA successful partnership with a community-based organization that supports individuals with disabilities resulted in a newly designed mHealth system with features to support community integration.

Transgender care is patient care.

In today’s era of patient-centered care, pharmacists have boundless opportunities to create a welcoming environment for transgender patients and help them reach their personal health goals. “I think there is a lot of opportunity to get creative and identify ways that you can be a gender-affirming provider, identify any barriers in your practice that your patients express to you or that you identify as gaps, and work to correct them,” said Cheyenne Frazier, clinical assistant professor of pharmacy at Washington State University in Spokane and lead speaker at the 2021 Midyear session “Caring for Transgender People: Insights and Points of Controversy in Medication Therapy.” Frazier shared how she rethought her assumptions about sex and gender and learned to communicate in ways that better respect patients’ wishes and put people at ease. “We all develop implicit biases based on our upbringing, the culture we’re around, the media that we’re exposed to,”...

The little things are big: evaluation of a compassionate community approach for promoting the health of vulnerable persons

BackgroundVulnerable persons are individuals whose life situations create or exacerbate vulnerabilities, such as low income, housing insecurity and social isolation. Vulnerable people often receive a patchwork of health and social care services that does not appropriately address their needs. The cost of health and social care services escalate when these individuals live without appropriate supports. Compassionate Communities apply a population health theory of practice wherein citizens are mobilized along with health and social care supports to holistically address the needs of persons experiencing vulnerabilities.AimThe purpose of this study was to evaluate the implementation of a compassionate community intervention for vulnerable persons in Windsor Ontario, Canada.MethodsThis applied qualitative study was informed by the Consolidated Framework for Implementation Research. We collected and analyzed focus group and interview data from 16 program stakeholders: eight program clients, three program coordinators, two case managers from the regional health authority, one administrator from a partnering community program, and two nursing student volunteers in March through June 2018. An iterative analytic process was applied to understand what aspects of the program work where and why.ResultsThe findings suggest that the program acts as a safety net that supports people who are falling through the cracks of the formal care system. The ‘little things’ often had the biggest impact on client well-being and care delivery. The big and little things were achieved through three key processes: taking time, advocating for services and resources, and empowering clients to set personal health goals and make authentic community connections.ConclusionCompassionate Communities can address the holistic, personalized, and client-centred needs of people experiencing homelessness and/or low income and social isolation. Volunteers are often untapped health and social care capital that can be mobilized to promote the health of vulnerable persons. Student volunteers may benefit from experiencing and responding to the needs of a community’s most vulnerable members.

Do Japan's Health Care Personnel Meet the Personal Health Goals of the "National Health Promotion Program"?

To improve health among the population and reduce the societal burden of care and health-related costs in a rapidly aging environment, the Japanese government launched the "National Health Promotion Program in the 21st Century" (HJ21), which contains goals concerning areas such as lifestyle behavior and the use of preventive medicine. While health care personnel are responsible for guiding others' health choices, they may not maintain healthy lifestyles themselves. Whether these individuals are meeting the HJ21 goals has not yet been examined. This study aims to determine whether certified specialists in health management are meeting such goals, and to compare their performance with the national average. This is a cross-sectional survey study. Study participants, sourced from all prefectures in Japan, were specialists certified in health management. We measured data concerning demographic information, lifestyle (physical activity, nutrition, diet, sleep, rest, smoking, and alcohol use), and the use of preventive medicine. The study participants exhibited many characteristics of high health literacy. They had an overall healthy lifestyle and met most of the HJ21 goals of healthy lifestyle, and a high proportion underwent health maintenance examinations and cancer screenings. These practices and behaviors maybe associated with high health literacy and social engagement activities.

Use and impact of smartphone apps in mental health

Abstract As smartphone usage is more and more ubiquitous, the app market is flourishing in all fields, including health. Indeed, the availability and use of smartphone apps (SAs) in health has exponentially grown in recent years. It has been estimated that in 2018 there were over 97,000 health apps available and that, 15% and 8% of US phone users aged 18-29 and 30-49 years respectively had health apps installed on their mobile devices. Health apps might potentially support people health paths in multiple ways: channeling health education, enabling personal health data tracking, self-monitoring and goals setting, facilitating access to health records or compliance to treatment, fostering effective communication with healthcare providers and health services, as well as supporting clinical decision-making. Despite such large potential, still scant evidence is available on the impact of SAs on clinical outcomes in different fields of medicine, including mental health. With an estimated prevalence of around 450 million people currently suffering from mental disorders and 1 in 4 people in the world affected at some point in own life, mental disorders are a leading cause of ill-health and disability worldwide whose prevention and care might be enhanced by mHealth technology. The general aim of the presentation is to provide an overview on the use and impact of SAs in the field of mental health. Specific objectives are: i) to present a conceptual framework on how SAs might support mental disorders prevention, diagnosis and treatment, ii) to report on SAs use in mental health in different settings, iii) to collect and pool available evidence from observational and experimental studies on the impact of SAs use on different mental health outcomes, iv) to explore the quality, effectiveness and attributes of top-rated smartphone mental health apps and lastly, v) to suggest gaps in knowledge to be filled by future research.

Addressing Consumer and Patients’ Preferences and Needs Whole Health System of Care Improves Health and Well‐Being and Reduces Opioid Use for Veterans with Chronic Pain

Research ObjectiveVHA is piloting the Whole Health System of Care (WHS) at 18 sites to shift care from a disease‐focused “find‐it, fix‐it” model to one driven by patients’ personal health goals, to foster patient self‐management, and to improve well‐being. As part of the Comprehensive Addiction and Recovery Act, VHA initiated a demonstration program in 18 VA Medical Centers to implement WHS. We report on its impact on Veterans.Study DesignA longitudinal survey of Veterans with chronic pain at the 18 flagship medical centers. Veterans were surveyed at baseline and 6 months using 12 patient‐reported outcome measures. Outcomes were compared between Veterans who did not use WHS services and Veterans with different levels of WHS service use, using standardized mean differences/Cohen’s D. We conducted a longitudinal cohort analysis of Veterans who started using WHS after April 2018. This analysis compared opioid dose levels using administrative pharmacy data (quarterly morphine equivalents) for the 6‐month period before using WHS to opioid levels one year later. This analysis included Veterans from the same time periods who did not use WHS services.Population StudiedSurvey: a random sample of Veterans with chronic musculoskeletal pain at 18 VA medical centers; we report on 3622 patients who completed baseline and 6‐month surveys (response rate: 49.3% baseline; 74.2% follow‐up). Administrative cohort analysis: 112 202 Veterans with chronic pain who received continuous VA care between October 2017 and March 2019 and used &gt;2 WHS (without WHS services prior to April 2018) or no WHS throughout the evaluation period.Principal Findings46% of survey respondents and 5.9% of the administrative cohort used &gt;2 WHS services. Effect sizes for survey measures were small overall; however, those who used WHS services reported greater improvements in perceptions of care, engagement in health care and self‐care, life meaning and purpose, pain, and perceived stress. Opioid use among Veterans using WHS decreased 23% compared with 11% decrease among those with no WHS use.ConclusionsWHS use, especially high levels of WHS use, was positively associated with improvements in several patient‐reported health and well‐being outcomes. While effect sizes were small for survey measures over this 6‐month period, they are promising for the future impact of VHA’s WHS initiative. Administrative data identified meaningful reductions in opioid use among WHS users.Implications for Policy or PracticeThe use of WHS services among Veterans with chronic pain has important implications for pain management, and Veteran health and well‐being. Implementing a system of care that is designed to provide these services to patients presents an opportunity to radically change the way health care is delivered and impact patients’ lives and not just fix their diseases.Primary Funding SourceDepartment of Veterans Affairs.

Just How Credible Is Online Physical Activity Advice? Investigating Kinesiology Knowledge Translation In Lay Resources

PURPOSE: In the U.S. and globally, adults independently seek out online advice to support their personal health and fitness goals. In this study, we examined web articles specific to physical activity promotion. Our objectives were to determine the rate that web articles at least once provided advice consistent with national physical activity guidelines (PAGs) and determine if consistency with PAGs varied on the basis of production source (i.e., commercial, governmental, professional association, or voluntary health agency). METHODS: The Google search engine was used to locate free-to-access web articles focused on physical activity promotion, written in English, and used text as the main communication medium. Valid lay search strategies independently reviewed by three experts were used. The 2008 Physical Activity Guidelines for Americans 18 to 64 years of age were used to appraise the credibility of messages. Seventeen potential PAGs were referenced. RESULTS: A sample of 72 web articles published or updated between 2008 and 2018 was obtained (M = 2016.34, SD = 2.02). All web articles that comprised the sample presented PAG-related messages. The percent of the sample that lacked at least one consistent message ranged from 61.1% to 100% across the 17 PAGs. The level of inconsistency was significant for 15 PAGs, all p < .05. Production source was associated with consistency for five PAGs, all related to aerobic (endurance) physical activity, p ≤ .05, Cramer’s V ≥ .30. For the remaining 12 PAGs, the rate of consistency was equivalent across the production source groups, p > .05, Cramer’s V = .11-.26. Message consistency was lowest with guidelines for adults who have sedentary or modestly active lifestyles, M ≈ 3% of the study sample. CONCLUSION: Knowledge translation of physical activity guidelines is low in free online resources that lay adults may independently locate. This observation was irrespective of production source. The implications of this study’s results will be discussed, including ways that they pertain to ACSM’s National Roadmap to Improve Equity in Physical Activity Participation. In consideration of this study’s findings, as well as broader knowledge translation issues that have been raised by others, including in other countries (e.g., Canada), recommendations for future research will be provided.

How community sport programs may improve the health of vulnerable population groups: a program theory

BackgroundGroups at risk of exclusion from society appear to have a lower health status and more health-related problems. Prevention efforts in these groups are not always successful, and new ways have to be sought by which health messages can be delivered. Many agree on low-threshold sport activities, also called ‘community sports’, to be a powerful tool to target socially vulnerable groups. Until now, it has not been investigated how and when such sport initiatives may be able to impact health outcomes in socially vulnerable populations. This study aims at developing a program theory that clarifies the mechanisms and necessary conditions for sport programs to be effective in health promotion. Such a program theory may constitute a backbone for developing health promotion initiatives within a sport for development setting.MethodsWe developed a program theory using a realist research design. We build on an extensive data set consisting of the insights of key stakeholders and participants of various community sport organizations at the one hand, and on relevant theoretical frameworks at the other hand. Data were collected through participatory observations of soccer trainings and related group activities, interviews with key stakeholders and participants, document analysis and two focus groups with stakeholders from associated social partnership organizations.ResultsThe health promoting effect of community sport on socially vulnerable groups seems not to result from an improved physical condition or sport-technical skills as such, but from processes of experiential learning among peers, incremental responsibility-taking and reflexivity. On the condition that participants feel safe, are stimulated to reflect and enabled to become actor of themselves and their situation, these processes are likely to lead to increased self-esteem, self-efficacy and motivation to set and pursue personal (health) goals. The key-influencing factor in these processes is the coach, who therefore needs to be adequately skilled in, for example, social vulnerability, motivational coaching and group dynamics.ConclusionsThe program theory developed in this study offers insights in the mechanisms proper to, and necessary conditions for community sport to be a lever for health promotion in socially vulnerable groups. Motivational processes at individual level and group connectivity are at the basis of personal health goal-setting. One of the necessary conditions is that these processes are guided by community sport coaches skilled in the meaning and impact of social exclusion, and capable of connecting with the target group.